University of Tasmania, Australia

Over the past decade, there has been increasing professional and public concern in a number of countries about pharmaceutical opioid use and related harms. This has been driven by increases in prescribing of these drugs: although the increase in Australia has been less than in countries in Europe and the United States (US), nonetheless, between 1992-2007, the number of opioid prescriptions in Australia increased by around 300%. This increase in prescribing has been accompanied by increases in injection of some opioids by regular injecting drug users (IDUs); and increased concern about the appropriateness of prescribing these drugs for chronic non-cancer pain (CNCP). The use of opioids outside the bounds of a doctor’s prescription has been cause for concern because of the risk of iatrogenic dependence, and serious adverse events including opioid overdose: pharmaceutical opioids now comprise the majority of fatal and non-fatal drug overdoses in the US.

Despite this increasing concern, little is known about the magnitude of risk for such adverse events. Controlled trials have typically excluded patients with comorbid substance use problems and other complications, or have not screened for these problems. Many have also been of limited duration (~12 weeks) and have not examined aberrant drug use behaviours. Those of longer duration have had a small number of participants and are therefore lacking statistical power. Other studies have examined treatment of specific conditions, e.g. low back pain, or have evaluated a single drug or formulation of a drug.

There has been no research conducted in Australia examining the natural history of opioid prescribing and the risk of adverse events. Consequently, although there is evidence of increasing levels of opioid prescribing in Australia and internationally, little is known about the patterns of prescribing for individual patients, and the outcomes for these patients in the longer term.

This Scholarship is supported in part by a 5-year National Health and Medical Research Council project grant, which will involve a prospective cohort study of persons across Australia prescribed opioids for chronic non-cancer pain, following their progress over two years and examining the predictors of clinical outcomes over this period. Your contribution to the project will be supervised by Dr Raimondo Bruno in the School of Psychology, UTAS, but there will be the opportunity for co-supervision and close involvement with the national project team, which is led by Professor Louisa Degenhardt at the National Drug and Alcohol Research Centre, University of New South Wales.

Key aims of the project include: (1) examining the rates, patterns and duration of opioid analgesic prescribing across Australia; (2) estimating the population-level risk of adverse events among those prescribed opioids, including incidence of hospital stays, transfer to opioid substitution treatment, and mortality; (3) examining the demographic and clinical predictors of adverse events among a cohort of chronic non-cancer pain patients, including opioid abuse or dependence, medication diversion, other drug use, and overdose; and (4) to identify factors which predict poor self-reported pain relief and other indicators of clinical outcomes.

This series of studies aims to increase understanding about men’s coping and support needs and preferences in order to inform both policy and intervention in men’s health.

Contact:	Raimondo.Bruno@utas.edu.au
More Information:	Dr Raimondo Bruno